What is Topophobia? (An Overview)
In this blog we will discuss the symptoms, causes and treatment of Topophobia.
An intense fear of certain places/situations is called Topophobia. It is a type of specific phobia which comes under the category of anxiety disorders in the DSM-V.
Someone suffering from this phobia experiences extreme anxiety when exposed to a certain place or situation they fear.
One will get anxious, not only when they are exposed to the situation/place they fear but also when they think about being in that scenario.
A sufferer can also undergo full-blown panic attacks if the anxiety worsens.
Topophobia is a bit similar to Agoraphobia (a type of phobia in which one fears a situation) and or social anxiety.
In all cases, one tries to avoid a certain situation/place if they feel threatened by it.
A sufferer avoids being in a specific situation because of their fear. Though, this avoidance produces pleasant feelings in one, it can lead to OCD in the future.
Because these actions eliminate anxiety and validate the sufferer’s fear.
According to the DSM-V, these acts of avoidance and anxiety affects one’s social and occupational functioning.
For example, if one fears their school, they will avoid it, compromising their education.
One can also fear speaking in front of a group of people. Because of certain reasons, people are also fearful of going to their relatives house.
In the worst case scenario, one can also get terrified when going to the washroom because of a traumatizing event that might’ve happened to them.
Topophobia can also lead to one developing depression in the future.
Topophobia is an irrational fear of certain places or situations. The name originated from a Greek word ‘topo’ meaning place and ‘phobos’ meaning fear.
Symptoms of Topophobia
People with Topophobia, like in all other specific phobias experience intense anxiety when in a specific situation/place.
They’re unable to control this anxiety and thus end up feeling more anxious. This anxiousness, in extreme cases, can give rise to full-blown panic attacks.
Sufferers go into flight or fight mode because of an adrenaline rush. In this state, the body’s physiological responses help one make decisions when in fear causing situations.
They either decide to escape the situation (flight) or stay and combat their fear (fight).
In the case of Topophobia or any other type of specific phobia, the physiological symptoms that are produced when exposed to a fearful situation/place (including extreme anxiety) cause the person to escape or avoid that situation.
Sufferers don’t have the courage to fight with their fear because of the unpleasant, terrifying experience the body goes through.
Apart from anxiety, Topophobia has a number of other physiological symptoms which include:
- Extreme anxiety when in a fear causing situation/place
- Extreme anxiety by just thinking about a specific place/situation
- Avoiding the fear stimuli
- Full-blown panic attacks
- Inability to handle anxiety
- Muscle tension
- Increased heart beat
- Feelings of dizziness
- Screaming or crying
- Hot/cold flashes when in a flight or fight mode (A hot flash refers to the temporary heating up of the body when in a state of fear. And a cold flash means when the body suddenly starts to shiver or cool down, when encountered by a fear stimulus).
- Upset stomach
Out of these, one should have at least 3-5 symptoms, including anxiety lasting for at least 6-months, to be diagnosed with Topophobia.
Causes of Topophobia
Like every other specific phobia, Topophobia is a result of either genetics or a past traumatic experience.
Someone who has a family history of anxiety disorders or specific phobias has a higher chance of developing Topophobia than someone who doesn’t.
This is because they are genetically predisposed to develop it.
This genetic tendency to develop a mental disorder/specific phobia can also be referred to as a Diathesis-stress relationship.
According to this, one with a genetic predisposition will not develop symptoms of Topophobia until and unless there is some trigger event, instigating anxiety or fear of people.
A person suffering from the autism spectrum, schizophrenia or bipolar disorder are also at a higher risk of developing Topophobia, if not treated properly.
This type of phobia is more common amongst children who are between the ages of 13-18 years.
Any incident they might’ve gone through or heard about can lead to the formation of Topophobia.
The trigger event that one requires to experience Topophobia can be a past-traumatic event.
For example, someone might have experienced sexual or physical abuse in a specific place in their childhood.
Since then, they either developed a fear for that particular situation or they generalized this all places.
Someone can also develop this fear of a certain place/situation if they have seen any of their loved ones being afraid of or harmed in that specific place.
Parents also warn their child of not going to a certain place or being in a situation because of the potential damage it can cause. Children therefore, develop Topophobia.
Treatment of Topophobia
Topophobia like all other specific phobias has no exclusive type of treatment that is specifically designed to treat it.
Like all the other specific phobias, Topophobia is treated by a number of different therapies including, Exposure Therapy, Cognitive-behavioral Therapy (CBT) and or NLP that lowers the anxiety or other physical symptoms.
• Cognitive-Behavioral Therapy (CBT)
It is one of the most frequently used treatments for patients with almost all kinds of mental disorders.
Topophobia is defined as the irrational fear of a certain place/situation. Thus, the therapist helps the patient in replacing these irrational thoughts with more rational ones.
The patients are helped out in analyzing and justifying the way they feel about being in that specific situation/place.
Therapists assist them in uncovering the reasons behind their fear and later they provide them with alternate, pleasant thoughts.
The patient is told to maintain a thought diary (with ABCD column) which provides them a replacement for every irrational thought they have, when thinking about a particular situation.
The ABCD stands for:
· A (antecedents) a situation or triggering event.
· B (belief) the thought that comes to one’s mind when in that triggering situation.
· C (consequences) the symptoms/feelings caused by that event/thought
· D (dispute) alternate, rational thoughts provided by the therapist in an attempt to dispute/challenge those irrational beliefs.
This last section of the thought diary is what really plays a role in helping the person feel good/less anxious.
· Neuro-Linguistic programming (NLP)
It is a psychological approach that includes ways of trying to reach a personal goal. It links language, thoughts and patterns of behavior learned through experience.
The key elements of NLP are action, modeling and effective communication. It suggests that everyone has different ways of how they see the world.
By understanding a number of perspectives of others, patients who use NLP see the world through a combination of their personal views and that of others.
NLP therapists treat patients with Tophobia by making them understand their thoughts, behaviors and emotional state.
By having an insight of the patient’s own ‘personal’ view of reality, they assist them in forming new, positive thoughts.
NLP helps the patient in improving his state of thoughts about other people by understanding their cognitive-behavioral patterns.
Like CBT, this form of therapy is also very effective.
This another form of treatment used with patients suffering from specific phobia or anxiety disorders. It is used with patients who know the cause of their phobia.
First, the therapist collects the patients’ history of different fears. They then identify the real cause of the particular fear/phobia the patient has.
They then discuss any new/latest event that triggered their anxiety and fear in the past few weeks.
People coming with specific phobias are told to imagine their distress causing stimuli.
The therapist then works with the individual in order for them to overcome their fear. In the case of Tophobia, the patient will be advised on how to overcome his fear of a certain place/situation.
They do this by creating a positive imagery for the patients’ feared stimuli.
• Exposure Therapy
It is one of the most frequently used ways of treating patients with Topophobia (or any other kind of specific phobia).
In this therapy, the patient is exposed to the source of his fear over a certain span of time.
To begin with the therapy, the therapist exposes the patient to the least triggering stimuli, a picture of that certain place for example.
As the therapy progresses and the patient is able to control his anxious feelings, imagery can be used to take the treatment a step further.
In this part of the treatment the patient is asked to visualize/imagine a situation in which he is in that specific place/situation he fears.
During this process of imagery, one actually feels being in that particular situation or place, experiencing various senses.
Once the person successfully, without feeling anxious clears this step of the therapy, he is then exposed to a real situation/place he is afraid of.
While the patient is being exposed to different intensities of fear causing stimuli during the various stages of therapy, the therapist simultaneously teaches them coping exercises.
These include, breathing techniques or muscle relaxation methods to lower their anxiety, when in an actual fear/anxiety causing situation. This teaches them how to remain calm when exposed to the fear stimuli.
Before actually starting the exposure therapy, the therapist needs to figure out the intensity of the patient’s fear, as to deduce whether they will be able to undergo this treatment, without any physical or psychological harm caused to them during the exposure processes.
However, these steps desensitize one to their fear of a certain place/situation, by exposing them to that stimuli repeatedly, until they learn to undergo the situation without anxiety/panic attacks.
• Mindfulness-Based Stress Reduction (MBSR)
MBSR is a meditation therapy, used to manage stress or anxiety. It is an 8-week program which includes group sessions.
Mindfulness meditation and Hatha yoga are practiced in these sessions, lectures and group discussions are also done to talk about mental health and increase interactivity.
In mindfulness meditation the person is told to, for example, to focus on the sensations felt while breathing or the rhythm of the chest rising and falling during the process.
This distracts the person’s attention from something stressful to something which is neutral and soothing.
For quick and effective treatment, patients are also given a set of home works, for example 45 minutes of yoga and meditation sessions, 6 days a week and to record their results/feelings in a book or diary for 15 minutes a day.
• Drug Therapy
Drugs are used to reduce the physical symptoms caused by Topophobia. Drugs are very quick in effectiveness, as they start showing progress in the patients’ health at least 2 weeks after the medicine is taken.
This type of biological treatment is usually more effective if the cause of the phobia is only genetic. However, these drugs/medicines are not to be taken without a doctor’s prescription or consultation.
Two types of drugs are used in the treatment of this phobia:
i. Anti-anxiety Drugs
Medicines like Valium are anti-anxiety drugs.
They are most commonly used with patients who experience panic attacks and also lowers their anxiety by binding to receptor cells of the brain that cause these unpleasant symptoms.
These drugs, as the name suggests don’t only treat depression but are also very effective in treating phobias.
Medicines like Lexapro reduce the anxious feelings of a person and makes him feel calm. They need to be taken on a daily basis but not without a doctor’s advice.
Whether the cause of Topophobia, or any other type of specific phobia is genetics, environmental or both, the best and the most effective way of treating them is by using a combination of both biological treatments (drugs) with cognitive treatment (for example CBT/exposure therapy).
Frequently Asked Questions
Q1) What causes Topophobia?
Topophobia is caused either by a genetic predisposition or an environmental factor.
Such as a past-traumatic event can cause a person to have Topophobia, or the family history can also play a significant role.
Q2) What are the symptoms of Tophobia?
Symptoms of Tophobia include extreme anxiety, panic attacks, nausea, breathlessness etc.
Q3) Are medicines the only way one can treat Topophobia?
No. Medicines are one of the many possible, effective ways of treating this specific phobia.
Therapies like CBT, NLP or exposure therapy are used with patients to help them overcome their fear.
However, one can also be prescribed with medicines in order to maximize their progress and reduce the physical symptoms of the phobia.
Q4) What is the DSM-V criteria for Tophobia?
It is categorized under specific phobias.
According to the DSM-V criteria for all specific phobias, one must have anxiety lasting for at least 6-months and this anxiety should affect their social and occupational functioning.